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When reviewing the medical record of a client who is prescribed a cardiotonic, which condition would lead the nurse to contact the primary health care provider because the drug is contraindicated for use? Select all that apply.
- A. Digitalis toxicity
- B. Hypertension
- C. Cardiac tamponade
- D. Hypotension
- E. Ventricular tachycardia
Correct Answer: A,C,E
Rationale: The cardiotonics are contraindicated in the presence of digitalis toxicity and in clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardiomyopathy, or AV block.
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A nursing instructor is conducting a class on heart failure and the events that occur. The instructor describes which of the following as a result of increases in neurohormonal activity that occur with heart failure? Select all that apply.
- A. Decreased secretion of catecholamines
- B. Remodeling of the cardiac muscle cells
- C. Hypertrophy of the heart
- D. Increased need for oxygen
- E. Cardiac necrosis
Correct Answer: B,C,D,E
Rationale: Increased catecholamines lead to increases in neurohormonal activity that cause remodeling of the cardiac muscle cells, leading to hypertrophy of the heart, increased need for oxygen, and cardiac necrosis, which worsen the heart failure.
A client is prescribed a cardiotonic medication. Which of the following preadministration assessments should the nurse perform on this client?
- A. Inspect joints for swelling.
- B. Check for jugular vein distention.
- C. Inspect skin for rash.
- D. Obtain blood glucose levels.
Correct Answer: B
Rationale: The nurse should check for jugular vein distention as part of the preadministration assessment for the client prescribed a cardiotonic. The nurse need not inspect joints for swelling, inspect skin for rash, or obtain blood glucose levels as these interventions will not provide necessary information with regard to administration of a cardiotonic.
A nurse checks the serum digoxin level of a client and finds it to be increased. Which of the following would the nurse identify as possibly associated with this increase?
- A. Colestipol (Colestid)
- B. Verapamil (Calan)
- C. Clarithromycin (Biaxin)
- D. Calcium carbonate (Maalox)
- E. Spironolactone (Aldactone)
Correct Answer: B,C,E
Rationale: Increased serum digoxin levels can occur with verapamil, clarithromycin, and spironolactone. Antacids, such as calcium carbonate, and colestipol cause a decrease in serum digoxin levels.
To help control the nausea and anorexia that may occur as an adverse reaction during digoxin therapy, the nurse should recommend which of the following? Select all that apply.
- A. Eating frequent smaller meals
- B. Restricting fluids at mealtime
- C. Maintaining good oral hygiene
- D. Eating more protein
- E. Avoiding fluid intake 1 hour before and after meals
Correct Answer: A,B,C,E
Rationale: If the nausea or anorexia is not a result of toxicity but an adverse reaction to the drug, use nursing measures to help control the reactions. Offer frequent small meals rather than three large meals. Restricting fluids at meals and avoiding fluids 1 hour before and after meals help to control nausea. Helping the patient to maintain good oral hygiene by brushing teeth or rinsing the mouth after ingesting food will also help with nausea.
After receiving a loading dose of milrinone (Primacor), the nurse would assess the client for which of the following as most likely? Select all that apply.
- A. Hypertension
- B. Angina
- C. Hyperkalemia
- D. Headache
- E. Insomnia
Correct Answer: B,D
Rationale: The adverse reactions most likely to occur after the administration of milrinone (Primacor) to a client are ventricular arrhythmias, hypotension, angina, chest pain, headache, and hypokalemia.